How effective are triage systems for same day appointment requests in general practice?

Conditions

Triage systems in GP practice Not Applicable

Murdoch J, Varley A, Fletcher E, Britten N, Price L, Calitri R, Green C, Lattimer V, Richards SH, Richards DA, Salisbury C, Taylor RS, Campbell JL.

2015-04-1023 citations

10.1186/s12875-015-0263-4

The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial).

Campbell JL, Fletcher E, Britten N, Green C, Holt T, Lattimer V, Richards DA, Richards SH, Salisbury C, Taylor RS, Calitri R, Bowyer V, Chaplin K, Kandiyali R, Murdoch J, Price L, Roscoe J, Varley A, Warren FC.

2015-02-0146 citations

10.3310/hta19130

Telephone triage for management of same-day consultation requests in general practice (the ESTEEM trial): a cluster-randomised controlled trial and cost-consequence analysis.

Campbell JL, Fletcher E, Britten N, Green C, Holt TA, Lattimer V, Richards DA, Richards SH, Salisbury C, Calitri R, Bowyer V, Chaplin K, Kandiyali R, Murdoch J, Roscoe J, Varley A, Warren FC, Taylor RS.

2014-08-03135 citations

10.1016/s0140-6736(14)61058-8

Interventions

Three interventions will be compared: General Practitioner-led Telephone Triage: We will use the Stour Access System to deliver GP-telephone triage as designed in 2000 by a 4-partner teaching practic

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: All consecutive patients making telephone requests for same day consultations will potentially be included. All patients aged less than 12 and greater than or equal to 16 years requesting a same day consultation will be included in respect of the primary outcome measure.

Exclusion criteria

Exclusion criteria: We do not propose to include young people aged between 12 and 16 years in this study since this will involve receipt of a postal survey along with written consent to review notes to the young persons address - a process which we believe may inadvertently lead to a breach of confidentiality should third parties open or have access to the young person's mail. Parents/guardians of children aged less than 12 years will be invited to provide consent on behalf of the child. Adults greater than 16 years will be included.

Design outcomes

Primary

Measure	Time frame
Number of healthcare contacts taking place in the 4 week period following the index same day consultation request. The 'number of contacts' will include the initial clinical assessment contact, and will thus include the triage contact in the two intervention conditions. The total number of contacts per 1000 patients requesting same day consultations in each of the trial conditions will be derived from numbers of GP, practice nurse, GP out of hours, A&E, and (although they may not impact significantly on GP workload) NHS Walk In Centre attendances. Data collection, capturing information on timing (am/pm), and type (face to face, telephone, home visit, GP out-of-hours, A&E and WIC attendance) of primary care contacts in all trial practices will take place as part of a note review occurring at least 12 weeks after the index consultation request with data extracted from the primary care medical record.	—

Measure

Time frame

Number of healthcare contacts taking place in the 4 week period following the index same day consultation request. The 'number of contacts' will include the initial clinical assessment contact, and will thus include the triage contact in the two intervention conditions. The total number of contacts per 1000 patients requesting same day consultations in each of the trial conditions will be derived from numbers of GP, practice nurse, GP out of hours, A&E, and (although they may not impact significantly on GP workload) NHS Walk In Centre attendances. Data collection, capturing information on timing (am/pm), and type (face to face, telephone, home visit, GP out-of-hours, A&E and WIC attendance) of primary care contacts in all trial practices will take place as part of a note review occurring at least 12 weeks after the index consultation request with data extracted from the primary care medical record.

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Secondary

Measure	Time frame
1. Descriptive study of patient flow. We will describe the management and interim and final disposition of patients in the working day in which they request a same-day consultation up to the point of final contact within that working day for each of the trial conditions. 2. Primary care NHS resource use. We will capture NHS primary care resource use by monitoring the number of contacts resulting for patients in the three trial conditions as for primary outcome. To derive estimates of cost for each consultation type in 'same day' and 'follow up' phases we will also collect detailed information on the duration of primary care contacts in all trial practices. We intend to use a direct measure of the start and end of all participant consultations in each of the participating practices for each consultation type, and to do this for both 'same day' and 'follow up' periods separately since these represent very different types of clinician interaction. Timing data will be extracted from the electronic record at the time of note review. Non-attendance rates for allocated appointments in the month following the same day request will be described and compared between trial conditions using data extracted at practice record review. 3. Patient reported outcomes, collected by postal questionnaire 4 weeks following the request for a same day consultation: 3.1. Patient experience of care: We propose to use a modification of the new national GP patient survey instrument (NGPPS) for the purposes of monitoring patient experiences of care in this study. Areas addressed in NGPPS are highly pertinent to ESTEEM and include: 3.1.1. Getting through on the phone 3.1.2. Seeing a doctor 3.1.3. Waiting times 3.1.4. Opening hours 3.1.5. Experience of GP care 3.1.6. Experience of nurse care 3.1.7. Overall satisfaction 3.2. Safety: deaths within 7 days of same day consultation request (from practice records), and attendance at A&E within 4 weeks and number and length of stay of emergency hospit	—

Measure

Time frame

1. Descriptive study of patient flow. We will describe the management and interim and final disposition of patients in the working day in which they request a same-day consultation up to the point of final contact within that working day for each of the trial conditions. 2. Primary care NHS resource use. We will capture NHS primary care resource use by monitoring the number of contacts resulting for patients in the three trial conditions as for primary outcome. To derive estimates of cost for each consultation type in 'same day' and 'follow up' phases we will also collect detailed information on the duration of primary care contacts in all trial practices. We intend to use a direct measure of the start and end of all participant consultations in each of the participating practices for each consultation type, and to do this for both 'same day' and 'follow up' periods separately since these represent very different types of clinician interaction. Timing data will be extracted from the electronic record at the time of note review. Non-attendance rates for allocated appointments in the month following the same day request will be described and compared between trial conditions using data extracted at practice record review. 3. Patient reported outcomes, collected by postal questionnaire 4 weeks following the request for a same day consultation: 3.1. Patient experience of care: We propose to use a modification of the new national GP patient survey instrument (NGPPS) for the purposes of monitoring patient experiences of care in this study. Areas addressed in NGPPS are highly pertinent to ESTEEM and include: 3.1.1. Getting through on the phone 3.1.2. Seeing a doctor 3.1.3. Waiting times 3.1.4. Opening hours 3.1.5. Experience of GP care 3.1.6. Experience of nurse care 3.1.7. Overall satisfaction 3.2. Safety: deaths within 7 days of same day consultation request (from practice records), and attendance at A&E within 4 weeks and number and length of stay of emergency hospit

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Countries

United Kingdom

Outcome results

None listed